Pulmonary & Critical Care

Question 1

How to diagnosis cystic fibrosis in adults?

Answer 1

Pulm or GI symptoms

Initial: sweat chloride (less sensitive); repeat abnormal to confirm

DNA testing

Question 2

Diagnose & Treat:
hyperreflexia
myoclonus
hyperthermia
tremor
ocular clonus
anxiety

Answer 2

Serotonin syndrome
~use of 2 or more Rx with serotonin within hours

usually resolves after 24 hours
Use BZs PRN agitation, BP, HR
cyproheptadine

Question 3

Drug Ingestion: Drug & treatment

tachycardia
hypertension
diaphoresis
agitation
seizures
mydriasis
increased temperature
increased CK
increased creatinine

Answer 3

Cocaine

Treatment: BZs

Avoid beta blockers

Haloperidol may worsen hyperthermia

Question 4

Anaphylaxis Treatment

Answer 4

epinephrine .3-.5mL of 1:1000 (1mg/mL)
+ antihistamine for pruritus and rash
+ O2
+ IVF

Question 5

Diagnose:

young female, dyspnea on exercise, cysts on lung, fatigue, spontaneous pneumothorax, pleural effusion, lung hyperinflation, decrease diffusing capacity for carbon monoxide

Answer 5

Lymphangioleiomyomatosis

Question 6

Diagnose:

Occupation: cement, ceilings, pools, ships
pleural thickening, exudative pleural effusion, chest pain, dyspnea, cough, hoarseness, night sweats, dysphagia

Answer 6

Malignant pleural mesothelioma

~median survival: 6-8 months
~latency: 20-40 years

Question 7

Treat aspirin overdose

Answer 7

bicarb infusion, dextrose

Dx: mixed resp alkalosis/AG met acidosis

• tinnitus
• confusion
• hyperthermia

Target Urine pH: 7.5-8.0

Question 8

Diagnose:
dyspnea, cough, chest pain, dullness to percussion of chest, diminished/absent fremitus and breath sounds

-Possible co-morbids: distended neck veins, S3, crackles, B/L peripheral edema, lymphadenopathy, ascites

Answer 8

Pleural Effusion

2/2 heart failure, pneumonia, malignancy

Question 9

Diagnose and treat:

Dyspnea, SOB, wheezing during exercise

Answer 9

Exercise Induced Asthma
~bronchospasm with exercise
Tx: SABA (albuterol) 15 minutes before exercise; inhaled glucocorticoid or leukotriene

Question 10

Persistent Asthma Treatment

Answer 10

1. low dose inhaled GC - Flovent/Fluticasone
2. 1+LABA (salmeterol) - Advair
3. medium dose inhaled GC + LABA
4. High dose inhaled GC + LABA
5. oral GC

Question 11

Diagnose:

hospitalized 8 days ago with septic shock due to pneumococcal pneumonia and bacteremia. She required mechanical ventilation and was treated with glucocorticoids and neuromuscular blockers. Pneumonia and sepsis have resolved, but she is unable to be weaned from ventilation. awake and obeys commands but displays generalized weakness; she has decreased grip strength, distal lower extremity sensory loss, decreased tendon reflexes, and cannot raise her arms or legs.

Answer 11

Critical Illness Weakness

Identified risk factors include sepsis, multisystem organ failure, severe illness, prolonged immobility, and hyperglycemia.

Dx: Medical Research Council muscle scale.

improves over weeks to months, but may persist in a small percentage of patients for up to 2 years.

Question 12

Manage acetaminophen poisoning

Answer 12

N-acetylcysteine

mortality lowest if administered within 12 hours of ingestion

Question 13

Treat ICU-acquired weakness

Answer 13

Strategies to minimize ICU-acquired weakness include aggressive management of critical illness, early mobilization, and management of hyperglycemia.

Question 14

Treat asthma in pregnancy

Answer 14

Inhaled glucocorticoids, oral glucocorticoids, SABAs, leukotriene-receptor antagonists (montelukast, zafirlukast), and LABAs

Benefits outweigh risks